A comparison between lovastatin and gemfibrozil in the treatment of primary hypercholesterolemia.

A randomized, multicenter, double-blind, prospective, 18-week comparison of lovastatin with gemfibrozil was performed to compare their efficacy and tolerability in adults with types IIa and IIb primary hypercholesterolemia. Sixty men and 44 women aged 24 to 78 years participated in the trial. Each treatment group of 52 patients was closely matched by the randomization procedure. All participants met national cholesterol education program guidelines for evaluation and treatment. In all, 94 (90%) completed the 18 weeks of study. After 18 weeks of diet-plus-active treatment, lovastatin decreased serum total cholesterol and low-density lipoprotein (LDL) cholesterol significantly better than gemfibrozil (adjusted mean decreases were 63 vs 35 mg/dl for total cholesterol and 67 vs 28 mg/dl for LDL; p = 0.0001). Gemfibrozil was more effective than lovastatin in increasing high-density lipoprotein (HDL) cholesterol (8 vs 5 mg/dl adjusted mean HDL cholesterol increases; p = 0.0086) after 18 weeks. No significant differences in the adjusted mean ratio of total to HDL cholesterol were noted, but the lovastatin group had a significantly greater adjusted mean reduction in the ratio of LDL to HDL cholesterol (1.8 vs 1.3; p = 0.0013). The gemfibrozil group achieved significantly greater reductions in very low density lipoprotein (VLDL) cholesterol and triglycerides compared with the lovastatin group (adjusted mean decreases were 14 vs 1 mg/dl for VLDL cholesterol and 71 vs 15 mg/dl for triglycerides). After 18 weeks of lovastatin therapy, 49% of patients achieved goal LDL cholesterol, whereas only 9% of those who took gemfibrozil achieved this goal (p = 0.0001).